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Archive: Sep 2017

Since the late 19th century, labor unions have been around to protect the rights of workers and improve employees’ lives through the process of collective bargaining. A union is any group of people who work together for a common cause affecting the workplace. Unions throughout history have fought for fair wages, benefits, and better working conditions. They’ve also made great changes in statewide workers’ compensation programs. Without unions, California’s system would look much different today.

How Unions Pressure Employers for Improvements

In California, labor unions impact the workers’ compensation system by pushing for safety improvements, lowering the cost of insurance for employees, and enacting rules such as labor agreements that hold an employee’s job during injury/illness recovery. Unions enact these changes through a process called collective bargaining. Union workers and employers will meet to discuss the issue at hand. The union will present its argument, and employers will decide whether or not to agree to the union’s demands or present a counterargument.

Bargaining between the union and employers is ongoing, not just a one-time event. If the union is unsatisfied with the outcome of an effort, it can initiate a labor strike or work stoppage, putting pressure on the employer to concede to demands or strike a “bargain.” The success of these efforts will vary depending on the situation. When it comes to making improvements to California’s workers’ comp system, unions have had success in the past. Yet, union workers may find themselves facing separate rules when filing workers’ comp claims.

Union Employees and Workers’ Compensation

In some cases, union workers have more rights and employee protections than non-union workers. Like all other workers, union employees have the right to workers’ compensation benefits in California after job-related injuries or illnesses. However, since union jobs subject workers to collective bargaining agreements, workers’ comp claims and benefits may look different to union employees. The employer will set employees’ rights and duties regarding workers’ comp benefits. Union workers will have to obey these rules based on a collective bargaining agreement, which serves as a labor contract.

Union workers may need to follow different rules for filing workers’ compensation claims in California. At many workplaces, workers’ comp rules and provisions under collective bargaining agreements are the same as state laws. In some cases, however, they may differ. Ask your employer if special rules apply to you at your union job before filing. You will need to carefully review the collective bargaining contract to understand your rights and responsibilities after a workplace injury.

Most unions have welfare funds that may issue benefits to injured workers. Employers may contribute to these funds, while union trustees keep track of and administer them to workers. Union members may collect these funds for work-related injures, healthcare, dental work, paid leave, disability, and life insurance. Some labor unions maintain separate welfare funds specifically for work-related injuries. Discovering your rights as an injured union or non-union worker may require help from an attorney. Workers’ compensation lawyers can help California workers take the best actions for maximum benefits after a workplace accident.

Injured workers rely on benefit checks for the costs of daily living. Workers who cannot return to full-time work because of job-related injuries or illnesses will receive temporary disability (TD) benefits, partial disability benefits, or permanent disability benefits through the California Workers’ Compensation Program. When a workers’ comp check is late, the injured worker may not be able to pay for utilities, food, and other necessities. Find out what to do if this happens to you.

About Workers’ Comp Benefits in California

In California, a worker’s first TD check is due within 14 days after the employer learns of a job-related injury or illness that prevents the worker from doing his or her job. The injured worker should receive prompt payment from the claims administrator, along with a letter that explains how the administration calculated the payment. TD benefits replace lost wages when a worker has to miss three or more days of work, stay hospitalized overnight, and does not have the option of taking other work from the same employer during recovery.

Benefits for temporary disability include total disability (TTD) payments if you cannot work at all during recovery, or temporary partial disability (TPD) payments if you can still work but you receive less money while recovering. In general, TD benefits equal two-thirds of the workers’ gross wages lost during recovery. Workers cannot receive more or less than the maximum or minimum weekly amount according to state laws.

You should receive regular TD benefits every 14 days as long as you are eligible. If your first check does not come within 14 business days, or if subsequent checks are late, you have the right to contact the claims administrator. Delayed payments sometimes occur if the administrator cannot tell if workers’ compensation insurance covers your injury, or whether the injury requires TD benefits. Delays during injury investigation can last as long as 90 days.

Potential Recourse If Your Checks Are Late

If something delays an initial workers’ compensation claim at administration, the worker should receive a letter notifying of the delay, explaining why, and requesting any further information the claims administrator may need to move the process along. The worker should also receive an estimate of when the administrator will come to a decision. If there are additional delays, the worker will receive additional explanation letters.

If you are experiencing a delay in workers’ compensation payment without reasonable explanation, contact your claims administrator using the information you should have received on your initial workers’ comp claim letter. If you don’t have this information, ask your employer to get it for you. State your issue to the administrator and find out why your payments are late..

In some cases, workers can receive additional payment “rewards” for workers’ comp check delays. This can happen with or without a reasonable excuse for the delay. If the claims administrator sends a late payment and you filed your claim more than 14 days before payment was due, you could be eligible for an additional 10% of the payment. You could receive 25% of additional payment on each late payment (up to $10,000) if the administrator had no reasonable excuse for the delay. For help communicating with the CA workers’ compensation administrators, contact an attorney.

A drug formulary is a list of prescription drugs that healthcare practitioners use to identify medications that will offer the greatest overall value to patients. Drug formularies include brand name and generic drugs. A committee of local experts, physicians, and pharmacists create and maintain drug formularies, choosing medications based on safety and effectiveness. A new proposed drug formulary in the California Workers’ Compensation Program could reduce costs and make it easier for injured workers to obtain the medications they need.

Drug Formularies and Workers’ Compensation

Drug formularies are beginning to play important roles in states’ workers’ compensation programs. Jurisdictions are discovering the advantages of these lists in improving medical quality and cost of care to injured workers. Potential benefits of a drug formulary in workers’ comp include lower costs of drugs, decreased opioid use and abuse, diminished use of topical medications, and lower utilization review costs. As of today, just five states have adopted state-specific formulary systems, on top of two federally available formularies – the Reed Group formulary and the ODG formulary.

To be effective, a drug formulary must remain properly organized and maintained. There must be well-documented methodology involved in creating drug formularies, using evidence and accepted practice guidelines. When a state decides to create its own formula, it must create a committee to oversee the list’s content. The committee should provide guidance in creating the list, update entries regularly, and enlist the help of local professionals. This is the process that California is currently undergoing to create its new drug formulary laws.

Drug Formulary Laws in California

California is one of the latest states to propose a workers’ comp prescription drug formulary, with the goal of lowering costs and making the system more efficient. Assembly Bill 1124 first introduced drug formularies to CA’s workers’ comp program back in 2015. It passed the state Senate without issue. The new law will take effect January 1, 2018. It proposes modifications to the original bill, such as ensuring that drugs given to injured workers meet proper safety standards. The public has the chance to comment on the new law before it goes to vote.

Stakeholders in the latest bill are pushing for improvements to provisions of the drug formulary regarding weaning injured workers off drugs that would be exempt from prescribing under the new rules. Changes to the law center around preventing and reducing opioid overprescribing – an issue that has plagued the healthcare system and workers’ compensation for years. Under the proposed law, long-term opioid prescriptions will not longer exist without a diligent case review process. Doctors will have more time to place patients on alternative, non-opioid treatment plans, and patients will benefit from clarified weaning rules.

What the Drug Formulary Could Mean for You

If you’re an injured worker currently receiving medications on the California drug formulary, the new laws may affect your prescriptions. This is especially true if you’re taking prescription opioids for pain relief. The new law will potentially update drug listings and enact several other important changes to the way injured workers receive prescription medications. Stay updated on the latest news about the pending law if you or a loved one is an injured worker in California.

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